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Health Care Safety Net

As part of the California Health Care Almanac project, the California HealthCare Foundation (CHCF) funded HSC to conduct interviews in six California communities in 2011-12 to assess how the organization, financing and delivery of health care are changing, including preparations for health reform.

In recent years, local public hospitals have stayed afloat financially without abandoning their mission to care for low-income people by expanding access to primary care, attracting privately insured patients and paying closer attention to collection of patient revenues, among other strategies, according to a qualitative study by the Center for Studying Health System Change (HSC).

Safety net clinics, hospitals and other providers that care for uninsured and low-income people increasingly are seeking ways to coordinate services to increase access, improve quality and reduce costs, according to a study by HSC published in the August edition of Health Affairs.

Majority of Medicaid ED Visits for Urgent or More Serious Symptoms
July 2012

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a national study by the Center for Studying Health System Change (HSC).

A Long and Winding Road: Federally Qualified Health Centers, Community Variation and Prospects Under ReformNovember 2011

Tracing their roots to the civil rights movement and the 1960s’ War on Poverty, federally qualified health centers (FQHCs) have grown from fringe providers to mainstays of many local health care system safety nets, according to a study by the Center for Studying Health System Change (HSC).

Despite the economic downturn’s severe fallout on Miami’s tourism, real estate and construction sectors, some hospitals are expanding beyond their traditional geographic markets to compete for privately insured patients, according to a Community Report HSC.

Communities that formally build collaborative health care safety nets can offer lessons for national health reform by offering roadmaps on how to improve access, reduce the use of unnecessary emergency and inpatient care, and improve people’s health, according to a qualitative study by HSC published in the July edition of Health Affairs.

Early Impacts of the Recession on Health Care Safety Net ProvidersJan. 27, 2010

While the recession increased demands on the health care safety net as Americans
lost jobs and health insurance, the impact on safety net providers has been
mixed and less severe—at least initially—than expected in some cases,
according to a new HSC study of five communities—Cleveland; Greenville,
S.C.; northern New Jersey; Phoenix; and Seattle.

As suburban poverty increases, the availability of health care services for low-income and uninsured people in the suburbs has not kept pace, according to a new study by HSC of five communities—Boston, Cleveland, Indianapolis, Miami and Seattle..

Policymakers have focused primarily on increasing Medicaid reimbursement rates to increase physicians’ participation in Medicaid, although physicians often complain of payment delays and other administrative burdens associated with Medicaid. Linking state-level data on average reimbursement times to the 2004-05 Community Tracking Study Physician Survey, this study examines how Medicaid reimbursement time affects physicians’ willingness to accept Medicaid patients. Delays in reimbursement can offset the effects of high Medicaid fees, thereby lowering participation to levels that are closer to those in states with relatively low rates. Increasing these rates may be insufficient to increase physicians’ participation unless accompanied by reductions in administrative burden.

As private physicians and hospitals shed unprofitable patients and services,
safety net providers are balancing their mission to serve the needy with steps
to attract higher-paying patients to shore up their margins. To maintain financial
viability, some safety-net providers—the patchwork of hospitals, community
health centers (CHCs) and free clinics that either have an explicit mission
to serve low-income and uninsured patients or are widely recognized as playing
that role in their communities—are trying to limit exposure to uncompensated
care and adopting such private-sector strategies as renovating and expanding
facilities and focusing on lucrative specialty care to attract higher-paying
privately insured and Medicare patients.

Community Efforts to Expand Dental Services for Low-Income PeopleJuly 2008

Recognizing the difficulties low-income people face in getting dental care,
many communities are attempting to provide more dental services to vulnerable
residents, according to a study released today by the Center for Studying Health
System Change (HSC). Lack of dental care is the key contributor to oral health
problems, with low-income people and some racial and ethnic minorities receiving
fewer dental services than higher-income people and whites, according to the
Agency for Healthcare Research and Quality. Poor oral health may contribute
to other health problems, including heart and lung disease, stroke, and premature
births. Abscessed teeth can cause severe infections and even death.

Faced with more patients seeking care for non-emergencies, safety net hospital
emergency departments are working to redirect patients to outpatient clinics,
community health centers and private physicians, with varied results. Low-income,
uninsured and Medicaid patients often turn to emergency departments (EDs) for
care because they lack timely access to care in other settings, according to
the study. The growing reluctance of physicians and dentists to serve Medicaid
and uninsured patients, along with shortages of primary care physicians and
certain specialists, such as psychiatrists, in some communities make obtaining
clinic or physician appointments increasingly difficult.

The sensitivity of state budgets to economic cycles contributes to instability
in public health insurance eligibility, benefits and provider payments, as well
as support for safety net hospitals and community health centers.

Despite significant federal funding increases, community health centers (CHCs)—the
backbone of the nation's safety net—are struggling to meet rising demand
for care, particularly for specialty medical, dental and mental health services.
Since 2000, federal funding for federally qualified community health centers—key
providers of preventive and primary care for underserved people—has doubled
to nearly $2 billion annually in 2006, according to the Health Resources and
Services Administration (HRSA). More than 16 million patients—primarily
racial or ethnic minorities, low income, uninsured or covered by Medicaid—received
care at more than 1,100 federally qualified and look-alike health centers in
2006, up from just more than 10 million patients in 2001, according to HRSA.

A Widening Rift in Access and Quality: Growing Evidence of Economic DisparitiesDecember 2005

As health care gobbles up an ever-larger share of the U.S. economy, the inability
or unwillingness to ensure equal access to high-quality health care is fueling
a widening rift between rich and poor Americans.